XANTHOGRANULOMATOUS PYELONEPHRITIS - CRITICAL ANALYSIS OF 26 CASES AND OF LITERATURE
XANTHOGRANULOMATOUS PYELONEPHRITIS - CRITICAL ANALYSIS OF 26 CASES AND OF LITERATURE
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DOI：
10.1016/s0022-5347(17)57559-x
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发表时间：
1978-01-01
影响因子：
6.6
通讯作者：
ELDER, JS
中科院分区：
文献类型：
--
作者：
MALEK, RS;ELDER, JS
26例黄色肉芽肿性肾盂肾炎的表现与肿瘤性和其他炎性肾实质疾病非常相似。中年或老年妇女最常受到影响。大多数患者表现为贫血、慢性发热、疼痛性胁腹肿块和复发性尿脓毒症。13例患者存在某些肾源性肝功能障碍的特征。肾组织的细菌培养几乎总是阳性的，但其谱与膀胱尿的谱有很大不同。尿路造影显示，62%的患者出现肾脏肿块病变，38%出现肾结石，27%出现无功能肾。血管造影，没有一个肿块的研究是区别于肾上腺瘤。事实上，只有1例患者术前诊断正确。黄色肉芽肿性肾盂肾炎可分为3期。治疗包括弥漫性或晚期疾病的肾切除术（21例患者），局部和低分期疾病的病变肾段切除术（2例患者）和肾活检（3例患者）。黄色肉芽肿性肾盂肾炎没有复发，但在一些患者继续菌尿或高血压的发展。
Manifestations of xanthogranulomatous pyelonephritis in 26 patients closely mimicked those of neoplastic and other inflammatory renal parenchymal diseases. Middle-aged or older women were affected most often. Most patients presented with anemia, chronic febrile illness, a painful tender flank mass and recurrent urosepsis. Some features of nephrogenic hepatic dysfunction were present in 13 patients. Bacterial cultures of renal tissue were almost always positive, but the spectrum differed considerably from that of the bladder urine. Urographically, a renal mass lesion was encountered in 62% of the patients, nephrolithiasis in 38% and a functionless kidney in 27%. Angiographically, none of the 4 mass lesions studied was distinguished from hypernephroma. Indeed, a correct preoperative diagnosis was made in only 1 instance. There were 3 stages of xanthogranulomatous pyelonephritis recognized. Treatment consisted of nephrectomy for diffuse or advanced stage disease or both (21 patients), excision of the diseased renal segment for localized and low stage disease (2 patients) and renal biopsy (3 patients). Xanthogranulomatous pyelonephritis did not recur, but in some patients bacteriuria continued or hypertension developed.